Cognitive processing enables humans to selectively attend, filter, reflect and prioritise incoming information and integrate this with thoughts and ideas. These processes are particularly important for higher executive function. Executive functions are necessary for goal-directed behavior. They include the ability to initiate and stop actions, to monitor and change behavior as needed, and to plan future behavior when faced with novel tasks and situations. Executive functions include a set of cognitive abilities that control and regulate other abilities and behaviours, to allow humans to anticipate outcomes and adapt to changing situations. Further, the ability to form new concepts and think abstractly is often considered a component of executive function. In particular, this includes the cognitive functions of sequencing, organising and integrating social information and appears to be used during the complex interpersonal interaction which forms the basis of human social communication and interaction. Defective or abnormal cognitive processing can therefore become apparent in behaviours that are controlled by higher executive functioning. Defects in cognitive processing may result in hyper-focusing on a specific topic during conversation and/or an inability to process simultaneously the multiple lines of thought that usually and automatically take place in normal social interaction. Instead the individual may select a preferred, more comfortable, and probably more familiar topic. As a consequence, resistance to or difficulty in following the natural flow of conversation is apparent.
Furthermore, compliance with pharmacotherapy is a long standing and difficult problem with individuals both with and without attention and concentration impairment. Reduced compliance affects and potentially limits the efficacy of all interventions, frequently being the most limiting factor in providing sustained psychotherapeutic benefit. For example, the 12 month compliance rate for use of psychostimulants in adults is approximately 33%. The core areas of impairment appear to be in the sequence and organisation of thoughts. This is seen clinically with adults with a diagnosis of attention deficit hyperactivity disorder [(ADHD); a DSM-IV-TR disorder as described in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000), and Snyder, Nussbaum, & Robins (Eds.), 2006, ibid (especially Box 2) and Weiss & Murray, 2003] and most commonly treated with psychostimulants. The initial and at times dramatic improvement frequently gives way to a returning disorganisation, and non-adherence with medication and an eventual cessation of treatment. Unless there is a concurrent improvement in the automatic and effortless ability to process social information, the gains in motivation provided by the stimulant will inevitably wane resulting in the associated return of symptoms.